Medicare Made Easy: Understanding Enrollment, Coverage and Costs

Medicare consists of several different parts, each with different rules for enrollment, eligibility and costs. All of this doesn’t help make Medicare easy to navigate.

In this article, we will try to make the basics of Medicare easy for you to understand. The following guide can help you find some of the essential information you need to gain a clearer vision of some of your Medicare benefits.

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Medicare coverage options

One of the first things to understand about Medicare is that the program is actually divided up into four “parts:” Medicare Part A, Part B, Part C and Part D.

Part A

Medicare Part A (hospital insurance) provides coverage for:

  • Inpatient care at hospitals
  • Skilled nursing facility care
  • Hospice
  • Limited home health services

Medicare Part A is accepted by any doctor, hospital or other health care provider that accepts Medicare.

Learn more about Medicare Part A.

Part B

Medicare Part B (medical insurance) provides coverage for two general types of services: medically necessary services (which are necessary to diagnose or treat a medical condition) and preventive services (which help prevent illnesses or help detect them at an early stage).

Some of the services that Medicare Part B covers can include:

  • Inpatient and outpatient mental health care
  • Ambulance services
  • Doctor’s office visits
  • Durable medical equipment (DME), which can include, but isn’t limited to, crutches, walkers, oxygen equipment, hospital beds, blood sugar test strips and monitors, CPAP devices and other equipment

Part B of Medicare is optional. As with Medicare Part A, your Medicare Part B coverage is accepted by any doctor or DME supplier who accepts Medicare.

Learn more about Medicare Part B.

The combination of Part A and Part B together is often called “Original Medicare.”

Part C

Part C of Medicare is also known as “Medicare Advantage.”

Medicare Advantage plans are sold by private insurance companies and provide all the same coverage as Original Medicare. Many Medicare Advantage plans also typically offering some additional benefits not found in Part A or Part B.

Some of these additional benefits can include coverage for dental, vision or hearing care. Many Medicare Advantage plans offer prescription drug coverage and will sometimes even offer benefits like gym or wellness program memberships, such as SilverSneakers.

Learn more about Medicare Part C.

Part D

Part D of Medicare consists of standalone prescription drug plans (PDPs) that are sold by private insurance companies, and Medicare Advantage plans that offer Part D drug coverage.

Medicare Part D plans each have their own list of covered drugs, which is called a formulary. Drugs are typically placed on different tiers within this formulary, with each tier having a different cost.

Learn more about Medicare Part D.

Medicare costs explained

Many costs — including Medicare premiums, deductibles and copayments or coinsurance — are standardized for Part A and Part B.

Most people get premium-free Medicare Part A. If you have to pay for Part A, you could pay up to $437 a month in 2019.

Medicare Part B is optional comes with a monthly premium. The standard Part B premium in 2019 is $135.50 per month.

To better understand more of the costs associated with Original Medicare, review this helpful guide to Your Yearly Medicare Costs.

Because Medicare Advantage plans and Medicare Part D prescription drug plans are sold on the private market, many of the associated costs will vary from one plan, company or location to another.

Understanding Medicare eligibility

The most common way to become eligible for Medicare is to turn 65 years old and be a U.S. citizen. Some people under the age of 65 also qualify for Medicare if they have a qualifying condition or disability.

There are slightly different eligibility rules for each part of Medicare. The links below can help you more easily understand the eligibility requirements for each Medicare coverage option.

Medicare enrollment

If you automatically qualify for Original Medicare, you do not need to do anything to enroll. You will receive your Medicare card in the mail three months before your 65th birthday if you’ve already been receiving Social Security or Railroad Retirement Board retirement benefits for four months.

If you’re under 65, you’ll be automatically enrolled three months prior to your 25th month of receiving disability benefits from Social Security or the Railroad Retirement Board.

If you do not automatically qualify for Original Medicare, you may fill out a Medicare application. You do not need to be 65 years old yet in order to submit your application.

Signing up for Original Medicare

You can sign up for Original Medicare one of four ways:

Signing up for Medicare Advantage plans

The enrollment process for Medicare Advantage plans and Medicare Part D plans is a bit different from the Original Medicare enrollment process. One way you can enroll in one of these plans is to contact a licensed insurance agent.

Call TTY Users: 711 24 hours a day, 7 days a week to speak with a licensed agent who can compile a list of plans available in your area and help you complete the Medicare enrollment process in a way that is easy and straightforward.

Copyright © 2018 TZ Insurance Solutions LLC. All rights reserved.

MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.